MEDICARE: JERED BEECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1689497059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERED BEECH

Provider Business Mailing Address
First Line	:	PSC 482 BOX 2930
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96362-0030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 482 BOX 2930
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96362-0030
Country	:	US
Telephone Number	:	315-646-7430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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Directions to “ JERED BEECH ” Practice Location

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